Implementing a one-time screening for HIV at age 25 may be a cost-effective way to identify new infections.
A significant challenge for fighting the HIV/AIDS epidemic is that many patients with HIV are unaware of their status. Not only does this leave HIV-positive patients susceptible to adverse events, but also may increase the risk of spreading the infection. For these reasons, health advocates recommend that all individuals receive an HIV test.
The results of a study published by the Journal of Adolescent Health suggests that 25 is the optimal age to conduct a one-time HIV screening of the general population.
"The CDC currently recommends that every American be tested for HIV infection at least once between ages 13 and 64," said lead researcher Anne Neilan, MD, MPH. "We began by thinking that, if people are screened only once, it makes sense to get screened after the age when the most new HIV infections occur. We also thought that, if we accounted for all of the HIV testing that is already taking place in the US, an additional screening test for youth without known risk factors would be most useful at some point after age 18."
Many younger individuals may have a higher risk of contracting HIV than what may be identified by health care providers, according to the authors. Implementing a one-time screening at age 25 may help diagnose HIV infections earlier and start treatment before adverse events occur.
"It can be hard to talk to teens about their risk for HIV," said study co-author Commander Richard Dunville, MPH. "However, it is important that parents, health care providers and teens themselves have more information to decide if and when HIV screening is appropriate. Studies like this one and data about high-risk youth can help guide these informed decisions."
Included in the study were CDC data on new diagnoses in 2013, including disease stage. The goal of the study was to compare the results of implementing a one-time screening between 13 and 30 years.
The analysis indicated that screening at age 25 would result in the most improved rates of diagnosis and health outcomes, while remaining cost-effective, according to the study.
The authors cautioned that these results were not applicable to high-risk young adults who should be tested more often, including those who inject drugs and those with HIV-positive partners.
“For at-risk groups, HIV screening should occur much more frequently than once in a lifetime, since a single screen will only capture a very small proportion of the population with HIV,” said senior author Andrea Ciaranello, MD, MPH. “However, for young people who become infected by age 25, the gains in life expectancy and improvements in health outcomes, including viral suppression, from that one-time screening test would be substantial."
The authors found that HIV diagnoses occurring among individuals aged 13 to 29 years were highest among those aged 22 to 25 years.
"There is often a delay between when someone becomes infected with HIV and when they are diagnosed, so we cannot be certain at what age most infections are occurring," Dunville said. "Still, this study leads us to doubt that screening teens 18 and younger without risk factors would be a good use of limited resources."
The authors also noted that the potential benefits of a one-time HIV screening protocol at age 25 were reduced if patients did not remain adherent to antiretroviral therapy, according to the study.
"Interventions to support linkage to care and retention in care are critical," Ciaranello said. "Our study underscores the value of ongoing research supported by the National Institutes of Health to examine the most effective ways to improve health outcomes for youth with HIV."
While the ideal age to test is 25 years, the authors said that implementing the one-time testing for patients younger than 18 years would not be beneficial and is less cost-effective, according to the study.
"About half of all young people ages 13 to 24 with HIV have no idea they are infected, but fewer than 15% of adults with HIV are unaware,” Neilan said. “HIV screening is an important component of addressing this disparity. Our results indicate that focusing screening on teens 18 or younger without risk factors would be a less efficient use of a one-time screen than screening at a later age."